"Flashforward" imagery and anxiety in young adults: Risk mechanisms and intervention development

Lead Research Organisation: University of Oxford
Department Name: Experimental Psychology


Young adulthood (16-24 years old) is a crucial time in one's life. Many young adults begin to establish their independence through education, work and relationships. However, this is also a time when many people are vulnerable to mental health problems. One in five young adults are likely to experience a mental health disorder. Anxiety problems in particular can significantly disrupt a young adult's daily life and reduce their ability to thrive. Despite the need for mental health support, many young adults struggle with accessing it due to a variety of reasons, including stigma, long waiting lists, splitting of services (in the transition to adult services at age 18), and disruptions to care resulting from geographical mobility. We need new approaches to prevent and intervene early, which are also effective, accessible and appealing.

This fellowship explores a promising new intervention for anxiety problems that looks less like traditional "therapy" and is informed by recent scientific research. This research suggests that when people experience anxiety, they also spontaneously visualise future scenarios that are making them anxious. These are also known as "flashforward" mental images, because they rapidly and mentally project us into the future. The ability to imagine the future is really helpful, for example it can help us plan a trip or prepare for an interview. However, repeatedly visualising anxious scenarios can make them seem more real and more likely to happen, making anxiety worse. Therefore, it is important that we find ways to deal with these images to reduce their emotional impact. New research has shown that holding a visual image in mind while also doing certain activities (such as playing a popular shape-fitting videogame called Tetris) makes the mental image less intense, less vivid, and less likely to intrude afterwards. This is presumably because doing two activities at the same time can be difficult, particularly when both (holding an image in mind and playing Tetris) use similar (visual) brain resources.

There will be three separate projects to better understand these "flashforward" images in young adults, how they make anxiety worse, and how to change them. The first project will ask young adults to complete an online survey three times (with six-month gaps). This will help us understand if knowing about flashforward images at one time point can help us anticipate if anxiety problems will develop much later on (e.g. in six months to a year). The second project will ask young adults to complete multiple brief ratings per day (for two weeks) using their smartphones of their moment-to-moment experiences, an approach called experience sampling. This will help us understand how these mental images impact on their anxiety levels and associated problems in daily life. The third project will develop a new (Tetris-based) intervention and deliver it to a group of young adults. This will help us understand whether this new intervention can modify flashforward images, resulting in a reduction in anxiety levels and their associated problems. If so, this intervention can be tested in future in an even more rigorous way. Together, the three projects will help us know if this intervention has the potential to be an effective strategy for early intervention and/or prevention for anxiety problems for young people.

Young adults with lived experience of anxiety problems will be involved across all stages of the project from design to dissemination. For this purpose, a Youth Advisory Group will be set up with around 6 young adults while ensuring diversity (e.g. in sex, gender identity, ethnicity and socioeconomic background). A youth collaborator from this group (a role which can be rotated) will additionally help with more specific research activities, such as reviewing materials, data collection and subsequent analyses.

Technical Summary

The problem: Anxiety disorders are common and debilitating in young adulthood (i.e. young people aged 16-24). Anxiety problems can be detrimental to their transition towards independence. Young people (YP) often struggle to access mainstream mental health services due to long waiting lists and fragmented service provision.

Proposed solution: My overarching aim is to develop a novel, accessible and appealing intervention approach for youth anxiety problems by i) better understanding how anxiety difficulties develop and are maintained; ii) embracing digital mediums; and iii) leveraging youth involvement.
Key to this proposal is that intrusive emotional imagery characterises anxiety disorders, where mental images (e.g., in the mind's eye) can depict "flashforwards" of anticipated feared outcomes in the future, such as being hurt, humiliated or in danger. Such images are proposed to trigger, maintain, and exacerbate overly-threatening predictions and maladaptive avoidance.

Research plans: I will conduct three interlinked studies to delineate if flashforward imagery is a suitable intervention target for youth anxiety. Specifically, these studies will test if flashforward imagery represents a i) distal risk (an online three-wave longitudinal study); ii) proximal risk (a smartphone-based experience sampling study in daily life); and iii) modifiable risk (a feasibility randomised controlled trial testing a Tetris-based intervention to disrupt flashforward imagery linked to anxiety symptoms).

Potential outcomes: An intervention will be developed which could have wide reach. It exploits a freely available game, requires minimal language, and can be increasingly adapted for more convenient delivery formats in future (e.g., remote). Dissemination will target young adults, frontliners working with them, and researchers. Given the fragmentation of services for this age group, local and national stakeholders will be mapped to inform future implementation pathway.


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